ost radical prostatectomy bladder neck contracture is known.First line of treatment is to perform bladder neck incisions either with cold or hot knife and laser.For recurrent stenosis when lumen is present one may need open/robotic YV pasty or BMG inserted posteriorly.Obliterative and recurrent bladder neck stenosis requires a redo Vesico-Urethral anastomosis.
[Robotic urethral reconstruction: redefining the paradigm of posterior urethroplasty .Timothy C. Boswell, Kevin J. Hebert, Matthew K. Tollefson, Boyd R. Viers Transl Androl Urol 2020;9(1):121-131 | http://dx.doi.org/10.21037/tau.2019.08.220
The redo anastomosis is challenging due to previous surgery and/or radiation.Robotic repair abdominally is now getting popularity. Ocassionally one may need perineal mobilisation of the bulbar urethra and abdominal (Robotic) anastomosis. These patients will be incontinent and may need an artificial sphincter.
Trauma as etiology :
Few anecdotal reports of use of robot in posterior urethroplasty have been available.
The patients in our subcontinent merit perineal approach and anastomosis from perineum.
Rarely abdominal approach is needed.
Even in robotic posterior urethroplasty,the perineal approach still remains standard to mobilise bulbar urethra, crural separation,inferior pubectomy. This cannot be done by a Robot abdominally.
I would divide Membranous Urethra in 2 half,Proximal and distal.
Stenosis of proximal side (Post Prostatectomy) merit Robotic approach.
Stenosis of distal side (Pelvic Fracture Urethral Injury) merits perineal approach .
Please see the attached image of management of Non traumatic conditions.
Open Perineal approach with bulbar mobilisation,crural separation ,inferior pubectomy will stay as the main approach for majority of posterior pelvic fracture urethral injuries.
Robot is indicated in management of bladder neck issues and redo vesicle urethral anastomosis arising out of treatment of prostate cancer.